Acetabular Fractures: What Radiologists Should Know and How 3D CT Can Aid Classification

Abstract

Correct recognition, description, and classification of acetabular fractures is essential for efficient patient triage and treatment. Acetabular fractures may result from high-energy trauma or low-energy trauma in the elderly. The most widely used acetabular fracture classification system among radiologists and orthopedic surgeons is the system of Judet and Letournel, which includes five elementary (or elemental) and five associated fractures. The elementary fractures are anterior wall, posterior wall, anterior column, posterior column, and transverse. The associated fractures are all combinations or partial combinations of the elementary fractures and include transverse with posterior wall, T-shaped, associated both column, anterior column or wall with posterior hemitransverse, and posterior column with posterior wall. The most unique fracture is the associated both column fracture, which completely dissociates the acetabular articular surface from the sciatic buttress. Accurate categorization of acetabular fractures is challenging because of the complex three-dimensional (3D) anatomy of the pelvis, the rarity of certain acetabular fracture variants, and confusing nomenclature. Comparing a 3D image of the fractured acetabulum with a standard diagram containing the 10 Judet and Letournel categories of acetabular fracture and using a flowchart algorithm are effective ways of arriving at the correct fracture classification. Online supplemental material is available for this article.

Core curriculum illustration: posterior column acetabular fracture

“…The result is a coronal oblique fracture extending through the posterior column of the acetabulum, from the greater sciatic notch posterosuperiorly to the obturator foramen, and subsequently through the inferior pubic ramus [3]. As in our case, there is often medial displacem e n t o f t h e f e m o r a l h e a d , w h i c h i s d r i v e n posteromedially at the time of injury.…”

“…Posterior acetabular fractures, particularly when associated with posterior hip dislocation, increase the risk of injury to the sciatic nerve and inferior gluteal artery and vein; hence, special attention should be paid to these structures on the initial CT. Close inspection for associated femoral head fractures and areas of marginal impaction of the acetabulum are important, as these indicate a poorer prognosis following surgery. Given the often high energy mechanism of injury resulting in these fractures, there are often additional injuries to the abdomen and pelvis, which should always be sought in these patients [3].…”

Management of complex acetabulum fractures and their consequences

“…В клинической практике большинство хирургов пользуются классификацией, предложенной французскими ортопедами R. Judet и E. Letournel (1981 г. ) [4] (рис. 1).…”

Learning Acetabular Fracture Classification using a Three‐Dimensional Interactive Software: A Randomized Controlled Trial

“…Acetabular fractures are a real challenge for academic orthopedic surgeons. Correct classification of acetabular fractures is critical to understand the fracture pattern, formulate an appropriate treatment plan, conduct case communication and predict prognosis especially due to the associated fatal risks (Scheinfeld et al, ). There are currently three principal classification systems used for acetabular fractures: the Judet and Letournel system (Letournel, ), Orthopedic Trauma Association (OTA)/Arbeitsgemeinschaft fur Osteosynthesefragen (AO) system (Marsh et al, ), and a more recent classification system (CT‐based classification) proposed by Harris et al ().…”

“…There are currently three principal classification systems used for acetabular fractures: the Judet and Letournel system (Letournel, ), Orthopedic Trauma Association (OTA)/Arbeitsgemeinschaft fur Osteosynthesefragen (AO) system (Marsh et al, ), and a more recent classification system (CT‐based classification) proposed by Harris et al (). Among them (Letournel, ; Harris et al, ; Marsh et al, ), the Judet and Letournel classification system for acetabular fractures provides important guidelines for orthopedic surgeons and is the most common means of assessment of comparability between different clinical reports (Beaulé et al, ; Clarke‐Jenssen et al, ; Scheinfeld et al, ). According to the Judet and Letournel classification system, acetabular fractures are categorized to two major types: simple and associated fracture types, with five specific fracture sub‐types in each major type (Letournel, ).…”